The American Podiatric Medical Association has released a new video on the Diabetic Foot, including consequences of vascular compromise (decreased blood supply) to the foot.
To view the video clip on APMA's official YouTube channel, please CLICK HERE.
Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
http://www.UtahFootDoc.com
Tuesday, November 24, 2009
Tuesday, August 18, 2009
Exercise Doesn't Always Help Diabetes...
Regular exercise can often improve diabetes symptoms and even improve the insulin sensitivity in a diabetic. In many studies, it has been shown to decrease the risk for diabetes type 2 and may even help someone decrease the medication use for this disease. This is accomplished through multiple mechanisms, but the best understood includes proliferation of glucose transport molecules that move to the cell membrane and bring glucose into the cells.
In a recent study, it was found that daily vitamin supplementation with vitamin C or vitamin E failed to improve insulin sensitivity when combined with exercise. It was therefore concluded that these antioxidants reduces the beneficial effects of exercise to health. Therefore, as opposed to vitamin supplementation with exercise, the natural vitamins from a diet rich in fruits and vegetables is a better combination with exercise to continue to have the health benefits of exercise.
For more information: Ristow M et al. Antioxidants prevent health-promoting effects of physical exercise in humans. Proc Natl Acad Sci U S A 2009 May 26; 106:8665. [Free full-text online] [Medline® Abstract]
Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
http://www.UtahFootDoc.com
In a recent study, it was found that daily vitamin supplementation with vitamin C or vitamin E failed to improve insulin sensitivity when combined with exercise. It was therefore concluded that these antioxidants reduces the beneficial effects of exercise to health. Therefore, as opposed to vitamin supplementation with exercise, the natural vitamins from a diet rich in fruits and vegetables is a better combination with exercise to continue to have the health benefits of exercise.
For more information: Ristow M et al. Antioxidants prevent health-promoting effects of physical exercise in humans. Proc Natl Acad Sci U S A 2009 May 26; 106:8665. [Free full-text online] [Medline® Abstract]
Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
http://www.UtahFootDoc.com
Tuesday, May 19, 2009
Botox For Diabetic Nerve Pain
In a recent study found in Neurology (28 April 2009), a group of scientists tested the use of injections of botulinum toxin type A—better known as Botox— into the skin on top of the foot to treat neuropathy pain. In this study, 44% were noted to have significant improvement of their pain after multiple treatments with botox. The question is whether this is a good idea.
Neuropathy pain is problematic and often difficult to treat. For years, people have been told that no treatment is available. If this were truly the case, Botox would be a good option. If it is typical Botox, however, it would require recurrent treatments throughout life to maintain the relief. And there is also a large concern for risks of injecting this substance into the skin of a diabetic without normal nerve feeling.
The truth is, however, that many diabetics are finding relief from their pain from the following options:
Monochromatic Infrared Therapy (MIRE or Anodyne): Infrared light therapy provided at a regimen of 2-3 times a week for 12 treatments. This has been shown in studies to improve some in many individuals, but has also be shown to be ineffective in many individuals.
It stimulates Nitrous Oxide (NO) release from the blood cells that interactes with surrounding tissues and decreases nerve pain, stimulates vasodilation (opening of blood vessels to increase circulation), increases nerve functioning. Often it has been shown to return sensation to a previously numb foot.
Metanx: This is a prescription medical food for the dietary management of endothelial dysfunction in patients with diabetic peripheral neuropathy. Traditional over-the-counter vitamins are synthetic forms of the nutrients found in nature and must be converted to their active forms before they can actually be used by the body's cells for such vital functions as DNA production, cell reproduction and homocysteine metabolism.
B Vitamin Active Form
Folic acid L-methylfolate (2.8mg)
Vitamin B6 Pyridoxal 5'-phosphate (25mg)
Vitamin B12 Methylcobalamin (2mg)
Metanx is a unique formulation providing the active forms of folate, vitamin B6 and vitamin B12 to manage the distinct nutritional requirements of neuropathy patients who often experience numbness, tingling, and burning sensations in their feet. Per studies run by the makers of Metanx, one tablet is equivalent to taking 19 folic acid tablets (1mg each), 2 B12 tablets (1mg each), and 2 B6 tablets (25mg each). You would need to take a handful of over-the-counter tablets to equal one dose of Metanx. Metanx is given at 1 tablet twice a day.
Neuremedy: This is a medical food consisting of benfotiamine, that nourishes dysfunctional nerves allowing them to conduct impulses more normally. Since the early 1960s, benfotiamine has been used successfully to treat neuropathy in Asia and Europe. Has has extensive studies that show it to be both effective and safe. It has recently been brought to the USA for treatment of neuropathy in our population.
Adequate blood levels of the micro-nutrient thiamine (Vitamin B1) are essential for the proper functioning of the nervous system. Recent studies have shown that many people suffering from peripheral neuropathy have low plasma levels of this essential micro-nutrient. They are unable to maintain adequate plasma thiamine levels through normal dietary means, or even through most of the B complex vitamins. They need a more bioactive form of thiamine for their nerves to function properly. In populations like diabetics, the elderly or neuropathy patients from other causes, Neuremedy alleviates the symptoms of peripheral neuropathy by delivering a highly bioactive form of the micro-nutrient thiamine to where it is needed, the nerve cells. Neuremedy works by nourishing the nerves.
Due to its overall efficacy, often people will experience improvement within days of starting the treatments. It does not reduce the symptoms of neuropathy for everyone, but is definitely a viable options. Neuremdy is dosed at one capsule twice a day.
Evening Primrose Oil: This is an herbal medication consisting of an oil from a plant native to North America that has yellow flowers that bloom in the evening. This oil extract contains up to 25% of essential fatty acids including linoleic acid (LA) and gamma-linolenic acid (GLA), an essential fatty acid. Essential fatty acids are required by the body for growth and development, and must be obtained from the diet. This formulation of LA and GLA are effectively absorbed and utilized by the body. At correct dosages, it has been shown to reduce symptoms of neuropathy including numbness, tingling, pain, burning, or lack of sensation.
Evening Primrose Oil is usually dosed at 2000mg (2 grams) daily, but can be increased to 3000mg (3 grams). Precautions include some side effects that are rare and mild, and include nausea, stomach pain, and headache. Stomach pain and loose stools may be indications that the dosage is too high. There are also some reports of seizure induction if a patient has a history of seizure disorders.
For additional information, please visit our website at http://www.utahfootdoc.com/
Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
http://www.UtahFootDoc.com
Neuropathy pain is problematic and often difficult to treat. For years, people have been told that no treatment is available. If this were truly the case, Botox would be a good option. If it is typical Botox, however, it would require recurrent treatments throughout life to maintain the relief. And there is also a large concern for risks of injecting this substance into the skin of a diabetic without normal nerve feeling.
The truth is, however, that many diabetics are finding relief from their pain from the following options:
Monochromatic Infrared Therapy (MIRE or Anodyne): Infrared light therapy provided at a regimen of 2-3 times a week for 12 treatments. This has been shown in studies to improve some in many individuals, but has also be shown to be ineffective in many individuals.
It stimulates Nitrous Oxide (NO) release from the blood cells that interactes with surrounding tissues and decreases nerve pain, stimulates vasodilation (opening of blood vessels to increase circulation), increases nerve functioning. Often it has been shown to return sensation to a previously numb foot.
Metanx: This is a prescription medical food for the dietary management of endothelial dysfunction in patients with diabetic peripheral neuropathy. Traditional over-the-counter vitamins are synthetic forms of the nutrients found in nature and must be converted to their active forms before they can actually be used by the body's cells for such vital functions as DNA production, cell reproduction and homocysteine metabolism.
B Vitamin Active Form
Folic acid L-methylfolate (2.8mg)
Vitamin B6 Pyridoxal 5'-phosphate (25mg)
Vitamin B12 Methylcobalamin (2mg)
Metanx is a unique formulation providing the active forms of folate, vitamin B6 and vitamin B12 to manage the distinct nutritional requirements of neuropathy patients who often experience numbness, tingling, and burning sensations in their feet. Per studies run by the makers of Metanx, one tablet is equivalent to taking 19 folic acid tablets (1mg each), 2 B12 tablets (1mg each), and 2 B6 tablets (25mg each). You would need to take a handful of over-the-counter tablets to equal one dose of Metanx. Metanx is given at 1 tablet twice a day.
Neuremedy: This is a medical food consisting of benfotiamine, that nourishes dysfunctional nerves allowing them to conduct impulses more normally. Since the early 1960s, benfotiamine has been used successfully to treat neuropathy in Asia and Europe. Has has extensive studies that show it to be both effective and safe. It has recently been brought to the USA for treatment of neuropathy in our population.
Adequate blood levels of the micro-nutrient thiamine (Vitamin B1) are essential for the proper functioning of the nervous system. Recent studies have shown that many people suffering from peripheral neuropathy have low plasma levels of this essential micro-nutrient. They are unable to maintain adequate plasma thiamine levels through normal dietary means, or even through most of the B complex vitamins. They need a more bioactive form of thiamine for their nerves to function properly. In populations like diabetics, the elderly or neuropathy patients from other causes, Neuremedy alleviates the symptoms of peripheral neuropathy by delivering a highly bioactive form of the micro-nutrient thiamine to where it is needed, the nerve cells. Neuremedy works by nourishing the nerves.
Due to its overall efficacy, often people will experience improvement within days of starting the treatments. It does not reduce the symptoms of neuropathy for everyone, but is definitely a viable options. Neuremdy is dosed at one capsule twice a day.
Evening Primrose Oil: This is an herbal medication consisting of an oil from a plant native to North America that has yellow flowers that bloom in the evening. This oil extract contains up to 25% of essential fatty acids including linoleic acid (LA) and gamma-linolenic acid (GLA), an essential fatty acid. Essential fatty acids are required by the body for growth and development, and must be obtained from the diet. This formulation of LA and GLA are effectively absorbed and utilized by the body. At correct dosages, it has been shown to reduce symptoms of neuropathy including numbness, tingling, pain, burning, or lack of sensation.
Evening Primrose Oil is usually dosed at 2000mg (2 grams) daily, but can be increased to 3000mg (3 grams). Precautions include some side effects that are rare and mild, and include nausea, stomach pain, and headache. Stomach pain and loose stools may be indications that the dosage is too high. There are also some reports of seizure induction if a patient has a history of seizure disorders.
For additional information, please visit our website at http://www.utahfootdoc.com/
Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
http://www.UtahFootDoc.com
Wednesday, April 1, 2009
You Can Control Diabetic Complications
On a regular basis, I talk with diabetic individuals that are scared of lose of a foot or toe. They are often told of the worst case scenarios and just told they need to be careful. My feeling has always been that education is the best way to limit further complications and problems. Therefore, I would like to provide some additional information here:
1. The best way to limit complications of diabetes (all the complications) is strict blood sugar control. You should be monitoring your blood sugar and seeking to have a A1c of 6 or lower. Spikes in blood sugar are not recommended at any time, as this provides opportunity for the complications to start. As you talk with your doctor, you can get an aggressive program to keep blood sugars managed.
2. Exercise helps control blood sugar. Exercise in a diabetic is an important part of your self care. This program should be under the direction of your physician and should include adjustments in medications as necessary, diet changes and carefully monitored exercise. Some key points include not exercising when blood sugars are highest, 30 - 60 minutes after meals and additional carbohydrates may be required to reduce hypoglycemia (low blood sugars). Talk with your doctor and get an exercise program that will work for you.
3. Examine your feet twice a day. The American Diabetes Association recommends you examine your feet daily for new areas of redness, new calluses, blisters, or skin changes. Since you are putting shoes on and taking them off, I recommend checking your feet twice a day. This provides you information on if a certain shoe or activity is causing any of these changes. If changes are noted to the feet, your feet should be checked by a foot and ankle specialist to help improve the problem before it becomes a bigger problem. As you examine your feet, you are performing the most important exercise to reduce wounds, infections and amputations.
4. Play an active part in managing your disease. No matter how good your doctor is, you are the key to good diabetic control. Learn all you can and work to reduce your diabetic foot complications (as well as other complications).
We help people on a regular basis manage foot and ankle complications of diabetes and hope by some of these simple techniques you can control your diabetic foot complications.
Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
http://www.UtahFootDoc.com
1. The best way to limit complications of diabetes (all the complications) is strict blood sugar control. You should be monitoring your blood sugar and seeking to have a A1c of 6 or lower. Spikes in blood sugar are not recommended at any time, as this provides opportunity for the complications to start. As you talk with your doctor, you can get an aggressive program to keep blood sugars managed.
2. Exercise helps control blood sugar. Exercise in a diabetic is an important part of your self care. This program should be under the direction of your physician and should include adjustments in medications as necessary, diet changes and carefully monitored exercise. Some key points include not exercising when blood sugars are highest, 30 - 60 minutes after meals and additional carbohydrates may be required to reduce hypoglycemia (low blood sugars). Talk with your doctor and get an exercise program that will work for you.
3. Examine your feet twice a day. The American Diabetes Association recommends you examine your feet daily for new areas of redness, new calluses, blisters, or skin changes. Since you are putting shoes on and taking them off, I recommend checking your feet twice a day. This provides you information on if a certain shoe or activity is causing any of these changes. If changes are noted to the feet, your feet should be checked by a foot and ankle specialist to help improve the problem before it becomes a bigger problem. As you examine your feet, you are performing the most important exercise to reduce wounds, infections and amputations.
4. Play an active part in managing your disease. No matter how good your doctor is, you are the key to good diabetic control. Learn all you can and work to reduce your diabetic foot complications (as well as other complications).
We help people on a regular basis manage foot and ankle complications of diabetes and hope by some of these simple techniques you can control your diabetic foot complications.
Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
http://www.UtahFootDoc.com
Monday, February 23, 2009
Jazz Owner Larry H Miller Dies From Complications of Diabetes
Larry H Miller is well known as the owner of the Utah Jazz NBA team, but also has multiple business and personal accomplishments that have helped rocket him to notoriety. He became co-owner of the Utah Jazz with a 50% purchase of the team on 11 April 1985. In June 1986, he purchased the remaining 50% and became the sole owner. He has since made it one of the most stable teams in the NBA.
Although Larry H Miller has been in declining health for several years, diabetic complications seemed to play a greater role in his health problems and his death. In June 2008, he suffered a heart attack and was hospitalized for 59 days with bleeding problems and kidney failure. In October of the same year, he developed a bone infection (osteomyelitis) from diabetic ulcerations. He underwent foot surgery at that time, and later progressed to below knee amputations of both legs “as a result of complications of diabetes.”
Larry H Miller’s story is not that different from many diabetics. Diabetes is becoming better known throughout the world as patients and physicians alike study and learn more about this growing disease. The American diet has been implicated with increasing the rate of diagnosis of diabetes, and greater complications are being recognized, including many parts of the body. Many of these complications affected Larry H Miller, but may not be directly related to his death, as he had a rare condition called calciphylaxis that may have aggrevated some of the complications of diabetes.
When you discuss complications of diabetes, three primary systems of the body should be discussed: 1) Circulation (blood flow), 2) Nervous System (nerves), 3) Immune System (infections). I will discuss each of these here.
First, circulation or blood flow, includes the heart and blood vessels that help supply the blood and oxygen throughout the body. In a diabetic, the blood vessels (arteries) become calcified and loose some of their elasticity. To a lesser extent, this can also affect smaller vessels. As part of these complications, people will often have decreased blood flow to the feet and legs and possibly even the hands. This decreased blood flow is often described as Peripheral Vascular Disease (PVD) or may interfere with healing of sores throughout the body. The blood flow issue may also interfere with the functioning of the heart and can lead to heart attacks, the functioning of the kidneys leading to kidney failure or affect the small vessels of the eyes causing decreased vision. Every system in the body needs blood flow to function as is worsened by the lack thereof.
Second, the nervous system or nerves, includes the peripheral nerves (nerves outside the brain or spinal column) and the autonomic system. Often these peripheral nerves will malfunction and produce a condition called neuropathy which can be seen as numbness, tingling, burning pain, electrical shocks or shooting pain, and hypersensitivity (over sensitive to minor stimuli). In these cases, the feet fail to function as they should and the protective nature of pain is disrupted. This can lead to calluses or blisters becoming sores that can become infected and heal poorly. It may also lead to poor balance as proprioception (feeling of pressure to feet) is disrupted. Nerve abnormalities can also lead to deformities of the feet including dryness as oils and sweat aren’t released as normal, and contracture or angling of toes as muscle fail to act normally (hammer toes or bunions).
Third, the immune system, includes the fighting of infections and the healing of wounds. A diabetic is unable to heal wounds or fight infections as well. This leads to simple conditions like Onychomycosis (fungal nails) and complex conditions like diabetic wounds and osteomyelitis (bone infections). The body fails to recover as it should and often produces long term wounds and health risks including possible toe, foot or leg amputations. Amputations then further increase the load on the heart and can lead to further health risks and even death.
The best ways to decrease the risks of these complications include strict blood sugar control, aggressive care by your diabetic specialist, regular examination of your feet and exercise.
Although complications can’t be completely eliminated, these modalities have been shown to improve overall diabetic health and long term results. Diabetes continues to lead to amputation and death, and should be aggressively understood and treated to improve everyday life. As we work together, we may be able to extend the lives of every diabetic and limit the complications they encounter.
Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
http://www.UtahFootDoc.com
Although Larry H Miller has been in declining health for several years, diabetic complications seemed to play a greater role in his health problems and his death. In June 2008, he suffered a heart attack and was hospitalized for 59 days with bleeding problems and kidney failure. In October of the same year, he developed a bone infection (osteomyelitis) from diabetic ulcerations. He underwent foot surgery at that time, and later progressed to below knee amputations of both legs “as a result of complications of diabetes.”
Larry H Miller’s story is not that different from many diabetics. Diabetes is becoming better known throughout the world as patients and physicians alike study and learn more about this growing disease. The American diet has been implicated with increasing the rate of diagnosis of diabetes, and greater complications are being recognized, including many parts of the body. Many of these complications affected Larry H Miller, but may not be directly related to his death, as he had a rare condition called calciphylaxis that may have aggrevated some of the complications of diabetes.
When you discuss complications of diabetes, three primary systems of the body should be discussed: 1) Circulation (blood flow), 2) Nervous System (nerves), 3) Immune System (infections). I will discuss each of these here.
First, circulation or blood flow, includes the heart and blood vessels that help supply the blood and oxygen throughout the body. In a diabetic, the blood vessels (arteries) become calcified and loose some of their elasticity. To a lesser extent, this can also affect smaller vessels. As part of these complications, people will often have decreased blood flow to the feet and legs and possibly even the hands. This decreased blood flow is often described as Peripheral Vascular Disease (PVD) or may interfere with healing of sores throughout the body. The blood flow issue may also interfere with the functioning of the heart and can lead to heart attacks, the functioning of the kidneys leading to kidney failure or affect the small vessels of the eyes causing decreased vision. Every system in the body needs blood flow to function as is worsened by the lack thereof.
Second, the nervous system or nerves, includes the peripheral nerves (nerves outside the brain or spinal column) and the autonomic system. Often these peripheral nerves will malfunction and produce a condition called neuropathy which can be seen as numbness, tingling, burning pain, electrical shocks or shooting pain, and hypersensitivity (over sensitive to minor stimuli). In these cases, the feet fail to function as they should and the protective nature of pain is disrupted. This can lead to calluses or blisters becoming sores that can become infected and heal poorly. It may also lead to poor balance as proprioception (feeling of pressure to feet) is disrupted. Nerve abnormalities can also lead to deformities of the feet including dryness as oils and sweat aren’t released as normal, and contracture or angling of toes as muscle fail to act normally (hammer toes or bunions).
Third, the immune system, includes the fighting of infections and the healing of wounds. A diabetic is unable to heal wounds or fight infections as well. This leads to simple conditions like Onychomycosis (fungal nails) and complex conditions like diabetic wounds and osteomyelitis (bone infections). The body fails to recover as it should and often produces long term wounds and health risks including possible toe, foot or leg amputations. Amputations then further increase the load on the heart and can lead to further health risks and even death.
The best ways to decrease the risks of these complications include strict blood sugar control, aggressive care by your diabetic specialist, regular examination of your feet and exercise.
Although complications can’t be completely eliminated, these modalities have been shown to improve overall diabetic health and long term results. Diabetes continues to lead to amputation and death, and should be aggressively understood and treated to improve everyday life. As we work together, we may be able to extend the lives of every diabetic and limit the complications they encounter.
Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
http://www.UtahFootDoc.com
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